Clinical Finance Case Management - Rn Specialist 2 - Revenue Cycle Clinical Support

The Ohio State University

Remote, US
Fully remote
Bachelor's degree in nursing
Current rn license required
2 years clinical care experience
The role functions within a multidisciplinary team to secure complex pre-authorizations and prevent or appeal clinical denials

Job Summary

  • The role functions within a multidisciplinary team to secure complex pre-authorizations and prevent or appeal clinical denials.
  • Candidates must utilize clinical knowledge to interpret medical necessity guidelines and determine the appropriate level of care for patients.
  • This position requires becoming a Subject Matter Expert for assigned payers and governmental requirements such as RAC, MAC, and QIO audits.

Matching Summary

The role functions within a multidisciplinary team to secure complex pre-authorizations and prevent or appeal clinical denials.

Skills & Requirements

Must-have

  • Bachelor's degree in nursing
  • Current RN license required
  • 2 years clinical care experience
  • Knowledge of payer guidelines
  • Experience with denial appeals
  • Proficiency in Microsoft Office

Nice-to-have

  • Strong analytical decision making
  • Ability to work independently
  • Collaboration with physician groups
  • Adaptability to changing rules
  • Subject matter expert status

Key Requirements

  • Bachelor's degree in nursing
  • Current active RN license
  • Minimum 2 years clinical experience
  • Experience collaborating with physicians
  • Proficiency in IHIS and 3M systems

Work Rights

Not specified

Tailored Resume

Cover Letter